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Individual

DR. DOUGLAS KEEN TAVENNER JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
20 MOUNTAIN GATE DRIVE, FREDERICK, MD 21703-6098
(301) 662-0100
Mailing address
20 MOUNTAIN GATE DRIVE, FREDERICK, MD 21703-6098
(301) 662-0100

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5112
MD

Other

Enumeration date
01/25/2007
Last updated
07/08/2007
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